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The following questions and answers are derived from the Vanderbuilt University Center For Human Nutrition web pages for gastric bypass surgery.
Gastric Bypass Surgery Questions and Answers
Dr. William O. Richards
Director of Bariatric Surgery at Vanderbilt Center for Human Nutrition
Who do you contact for an evaluation visit for the gastric bypass surgery?
If you are interested in the gastric bypass surgery after reading the information below, you can contact the Vanderbilt Center for Human Nutrition at 615-936-1288 to schedule an initial evaluation appointment.
What is gastric bypass surgery?
Roux-en-Y divided gastric bypass surgery is a procedure in which the stomach is separated making a small pouch. The intestine is then separated to reduce absorption. The basic steps are:
A row of titanium staples separates the stomach into a small upper pouch and a lower, large pouch.
The small intestine is separated from the stomach and cut into two pieces.
The intestine is then reattached to the upper pouch, allowing food to bypass the lower pouch.
The small intestine is then reconnected in the shape of a 'Y' about 40 inches below the stomach.
What is laparoscopic surgery?
This type of surgery allows the surgeon to perform surgery without making a large incision.
A tube is inserted into the abdomen
Carbon dioxide gas is gently pumped into the abdomen to expand it.
A tiny video camera is inserted through the tube.
The surgeon is able to 'see' into the abdomen by watching a monitor
The surgeon watches the monitor and uses surgical instruments that have been inserted through additional small incisions to perform the surgery.
How does the gastric bypass help you lose weight?
Your new stomach will only be able to hold about ½ cup of food.
Your appetite is decreased. After a few bites, you will feel full.
Dumping syndrome occurs when you eat foods high in sugar, such as a chocolate sundae. Dumping syndrome causes diarrhea, nausea, abdominal cramps and possibly vomiting.
You will learn to eat much healthier.
You won’t absorb as much because part of your intestine is not being used. For this reason, you will have to take vitamins everyday. Without vitamin and mineral supplementation, serious vitamin deficiencies may occur.
You will also be advised to take calcium supplements. Iron supplements may also be necessary, especially in younger women.
Who can benefit from this surgery?
Gastric bypass is most successful for people who meet the criteria listed below
A Body Mass Index of 40 or more (100 pounds or more overweight)
A documented history of weight loss attempts including diet, behavioral changes, and exercise is required
No medical or hormonal reason for the clinically severe obesity can be evident. These problems are very rare.
A good knowledge of the surgery and realistic expectations of weight loss and possible complications
A willingness to accept the risks of surgery
A willingness to make dramatic lifelong changes in lifestyle, dietary habits, and exercise
What are the risks and complications?
Early Complications
Respiratory complications
Constipation
Blood clotting, blood clots may migrate to the lungs
Bleeding during or after surgery
Leak or rupture
Incisional hernia
Bowel obstruction
Ulcers in your stomach
Gallstones
Nausea/vomiting
Late Complications
Bleeding from ulcers months or even years after the surgery
Bowel obstruction
Ulcers in your stomach
Gallstones
Malnutrition/nutrient deficiencies
Excessive skin folds following marked weight loss
Can I get pregnant after I have this surgery?
Women are advised to wait until at least 18 months after their surgery before considering pregnancy. This surgery causes some vitamins and minerals to be poorly absorbed which can cause serious birth defects.
Fertile women MUST use a medically accepted method of birth control such as abstinence, oral contraceptive pills with a barrier method such as a condom with spermicide, or surgical sterilization of partner for at least 18 months after the surgery.
What is the evaluation process for the surgery?
An initial evaluation with a specialist in internal medicine
An evaluation by a surgical specialist, if gastric bypass is an appropriate option for you
Evaluations by other specialists if necessary and possible additional tests if indicated
Two visits with a registered dietitian before surgery and two visits after surgery
An evaluation with a psychologist
What is my cost and does insurance cover it?
The initial health risk evaluation may or may not be covered by your insurance.
Call the number on the back of your card and ask if gastric bypass is a covered benefit.
Following your visit with the surgeon, Vanderbilt staff will send your health information to your insurance company and ask for predetermination.
If the insurance company agrees that the surgery is medically necessary, the staff will get a preauthorization from your insurance company.
When you have preauthorization, your surgery will be scheduled if you meet all the other requirements previously noted.
You will most likely have to pay out-of-pocket for the nutrition education with the registered dietitian.
What do I do to prepare for surgery?
No more than 30 days before surgery, you will have a visit to Preadmissions for a pre operative anesthesia evaluation. During this visit you will:
Have the tests you need before being admitted to the hospital
Receive necessary instructions
Learn from the anesthesiologist or registered nurse anesthetist the medications you need to take or not take before the surgery
Learn what time to arrive on the day of surgery and where to go
Eat low fat, small, sensible meals a few days before surgery
Do not eat or drink after 9 pm, take only small sips of water with any pills you have to take before surgery
You must abstain from tobacco use for 3 months prior to surgery
Keep your body especially clean
Remove nail polish
Bring any inhaler medications that you normally use
Bring your CPAP or BiPAP machine to the hospital and plan to use it while you are there.
What happens on the day of my surgery?
The operation is performed by your surgeon, assistant surgeon, and operating room nurses
The surgery lasts 2-4 hours
You will stay in recovery until fully awake, usually 4-6 hours
You will be taken to a room on a surgical unit
An incentive spirometer will be used to help your deep breathing every 2 hours
Special elastic stockings and compression boots will be on your legs as routine post-op therapy to help prevent blood clots
You may have a gastrograffin swallow x ray done to make sure your new stomach pouch is working correctly
For the first few weeks after surgery, your stomach and intestine will be healing and strengthening. In the unlikely event of repeated overeating, extreme pressure may occur causing the stomach or anastomosis to enlarge. Strict adherence to the liquid and pureed phase of the diet is very important.
You will usually be discharged on the second day after the operation.
How often do I have to see the doctor after the surgery?
You will see your surgeon a week to 10 days after your surgery, 6 weeks postoperatively, and 3 months postoperatively
You will visit the Vanderbilt High Risk Obesity Clinic 6 months post operatively and 12 months postoperatively, then once a year afterward
The support group meets every first and third Tuesday and is a great place to learn from post op patients and encourage pre op patients
Why do I have to see the dietitian four times?
The surgery provides a lifelong tool for dealing with clinically severe obesity, but diet, exercise and other lifestyle choices will determine the long-term results of the surgery.
The dietitian will help you make these adjustments to help you realize the best possible outcome. A general description of each visit is given below.
Visit One
Overview of the diet
Brief description of surgery procedure/hospital stay
General guidelines
Description of each diet phase
Importance of compliance
Liquids between meals
Limiting portion sizes
Adequate protein intake
Calcium/multi vitamin supplementation
Adequate fluid intake
Visit Two
Ways to consume adequate protein
Grocery shopping list
Reading a food label
Packing for the hospital
Importance of exercise
Visit Three
Transitioning to a soft diet
Weight loss adequate/appropriate?
Strength training
Ways to increase protein intake
Dealing with hair loss/nutritional deficiencies
Visit Four
Transitioning to a regular diet
Maintaining appropriate calorie level
Long term weight loss maintenance
Nutritional deficiencies
Increasing nutrient intake
Q/A Index
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